AAPM Newsletter January/February 2018 Vol. 43 No. 1

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Improving Health Through Medical Physics

AAPM PRESIDENT'S REPORT Bruce Thomadsen, PhD | Madison, WI AAPM Newsletter — Volume 43 No.1 — January | February 2018

THE ROAD AHEAD As President-Elect talking at various chapters, I would point to the recent member survey that showed that for the most part the AAPM membership is happy with the Association. Of the eleven major categories, the only one that did not reach a 4 out of 5 on the "happiness scale" was "AAPM helps members to anticipate the challenges and trends that will likely impact the medical physics community." Admittedly, that did get a 3.9, but it is a topic that AAPM is taking very seriously. In fact, the theme for this summer's annual meeting is "Beyond the Future", a contradiction intended to highlight planning farther than ve or even ten years from now. Currently, the healthcare situation seems to change daily. Well, maybe it only feels like that, but things are very unsettled. To help give AAPM direction and to try to get AAPM into a good position in the uncertain future, starting with the Spring Clinical Meeting, the Board of Directors will concentrate on strategic planning. Yes, all 50 of them! Of course, the discussion will have to be guided. Board members will prepare topics and questions for the whole to consider. The goal is to provide the beginning of a plan to maintain a vital AAPM - one that will continue to do well on the "happiness scale." The domain for the discussion will have to be vast, covering the environment for community-based practice and academics, radiotherapy and imaging, education and research, and ways to make AAPM welcoming to physics in medicine, whatever that may look like in the future. The rst order of business for the Board, however, is to approve the strategic plan that all of the councils and committees have been working on for the last two years. The document is not so much a strategic plan as a mission plan; that is, a guide to see that what the Association does - all of its activities - align with our mission statement. Discrepancies could lead to changes in what we do (usually adding actions we may be missing) or questioning how we have stated our mission.

AAPM is incredibly productive. Look at all the reports we generate and educational and scienti c programs we put on. This only happens because of the volunteer work of our members. Sometimes, the structure of our councils can impose hurdles to our work when the topic falls in more than one council or committee. An ad hoc committee has been formed to consider possible ways to ease impediments to projects resulting from our organizational structure. AAPM is its members and it needs your input and participation.

Improving Health Through Medical Physics

EXECUTIVE DIRECTOR'S REPORT Angela R. Keyser, PhD | Alexandria, VA AAPM Newsletter — Volume 43 No.1 — January | February 2018

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2018 AAPM FUNDING OPPORTUNITIES Summer Undergraduate Fellowship Program (Application Deadline: February 2, 2018)

The Summer Undergraduate Fellowship Program is designed to provide opportunities for undergraduate university students to gain experience in medical physics by working in a medical physics laboratory or assisting with clinical service at a clinical facility. In this program, AAPM serves as a clearinghouse to match exceptional students with exceptional medical physicists - many who are faculty at leading research centers. Students participating in the program are placed into summer positions that are consistent with their interest.

Students are selected for the program on a competitive basis to be an AAPM Summer Fellow. Each Summer Fellow receives a $5,000 stipend from AAPM. View additional information and access the online application »

Diversity Recruitment through Education and Mentoring Program (DREAM) (Application Deadline: February 9, 2018)

The American Association of Physicists in Medicine Diversity Recruitment through Education and Mentoring Program (DREAM) is a 10-week summer program designed to increase the number of underrepresented groups in medical physics by creating new opportunities, outreach, and mentoring geared towards diversity recruitment of undergraduate students in the eld of medical physics. Students participating in the program are placed into summer positions that are consistent with their interest. Students are selected for the program on a competitive basis to be a DREAM fellow. Each DREAM fellow receives a $5,000 stipend from AAPM. View additional information and access the online application »

Expanding Horizons Travel Grant (Application Deadline: February 21, 2018)

AAPM awards up to fteen travel grants per year, each up to $1000, for the purpose of providing additional support for student and trainee travel to conferences that are not speci cally geared toward medical physics. The travel grant program is designed to provide an opportunity to broaden the scope of scienti c meetings attended in order to introduce students and trainees to new topics which may be of relevance to medical physics research and which may subsequently be incorporated into future research in order to progress the eld in new directions. View additional information and access the online application »

AAPM Graduate Fellowship (Application Deadline: April 30, 2018)

AAPM Graduate Fellowship for the training of a Doctoral Candidate in the Field of Medical Physics is awarded for the rst two years of graduate study leading to a doctoral degree in Medical Physics. Both BSc and MS holders are eligible to apply. A stipend of $13,000 per year, plus tuition support not exceeding $5,000 per year will be assigned to the recipient. Graduate study must be undertaken in a Medical Physics Doctoral Degree program accredited by the Commission on Accreditation of Medical Physics Education Programs (CAMPEP). View additional information and access the online application »

Research Seed Funding Grant (Application Deadline: May 22, 2018)

Three $25,000 grants will be awarded to provide funds to develop exciting investigator-initiated concepts, which will hopefully lead to successful longer term project funding from the NIH or equivalent funding sources. Funding for grant recipients will begin on July 1 of the award year. Research results will be submitted for presentation at future AAPM meetings. Must be a member of AAPM at time of application (any membership category). View additional information and access the online application »


(Application deadline: May 22, 2018)

Best Medical will provide ve fellowships in the amount of $1,000 each, to be used for travel, food and lodging expenses to attend the 2018 AAPM 60th Annual Meeting & Exhibition. AAPM will provide complimentary Annual Meeting registration for each recipient, including social functions. View additional information and access the online application »

APSIT BENEFITS FOR AAPM MEMBERS AAPM members are o ered a range of insurance products through APSIT [The American Physical Society Insurance Trust] because of AAPM's a liation with the American Institute of Physics (AIP). APSIT was founded in 1969 to provide members with a convenient source for quality, a ordable insurance. Since that time, APSIT has expanded to include a broad range of insurance options that meet the needs of our sponsoring organizations' members. Plan premiums are regularly more a ordable than what is available through competitors, thanks to the power of group purchasing. Since AIP society members usually have higher education levels and tend to live more conservative lives, APSIT group rates are very competitive in the market. APSIT's governing board, charged with making decisions about which plans to provide, is comprised of representatives from participating member societies. I've been fortunate enough to serve on the APSIT board since 2009 and am currently Chair of the group. Pearl Insurance is the Program Administrator for APSIT. With over 60 years of industry experience, Pearl Insurance has acted as a third-party program administrator for several national rms and associations. Pearl Insurance's team can be reached Monday through Friday, from 7:00 AM – 7:00 PM CST at 800-2721637. Currently, members of any AIP society are eligible to purchase the following plans through APSIT:

Group Term Life Group 10-Year Level Term Life Group Disability Income Group Accidental Death and Dismemberment Long-Term Care Discount RX Card While it remains your decision as to whether any of these insurance products t your own needs, I encourage everyone to take advantage of the plans that are right for you. Visit APSIT Insurance for more information on each plan.

2018 DUES RENEWAL 2018 dues renewal notices were distributed in early October. You may pay your dues online or easily print out an invoice and mail in your payment. I am pleased to report that all twenty-one AAPM Chapters have elected to have HQ collect chapter dues. We hope that you will appreciate the convenience of paying your national and chapter dues with one transaction! AAPM's rules are very speci c regarding the cancellation of membership if dues are not paid by the deadline and there are fees required for reinstatement. As the administrative sta of AAPM, we must consistently enforce the rules of the organization. It would be very di cult to make exceptions for some members and enforce such fees on others. If you need any assistance or have any questions about the dues process, please contact Janelle Priestly, 571-298-1216.

YOUR ONLINE MEMBER PROFILE This is a reminder to keep your AAPM Membership Pro le information up to date by clicking here to make any changes necessary. Please, upload your picture if you have not already done so. Remember to review the "Con ict of Interest" area of the Member Pro le to self-report con icts per the AAPM Con ict of Interest Policy.

STAFF NEWS I am pleased to announce that Richard Martin has been promoted to the newly created position of Government Relations Program Manager. This promotion acknowledges the importance of AAPM's interactions with governmental agencies and legislatures on issues related to the profession and the practice of medical physics and Richard's increased level of responsibility in this area. I know that you will join me in congratulating Richard on this well-deserved promotion.

Improving Health Through Medical Physics

TREASURER'S REPORT Mahadevappa Mahesh, PhD | Baltimore, MD AAPM Newsletter — Volume 43 No.1 — January | February 2018

I would like to start the New Year with pleasant news about AAPM's nances. AAPM's nances continue to be on solid ground, however, we always have to be watchful of our revenues (trending down) and expenses (trending higher) along with the trends in the xed expenses of our Association. It has been a very active year as we started with the selection and purchase of both a Financial Management System (FMS) and Association Management System (AMS) and we are currently in the implementation stage with the goal of completely switching to new systems early this year. The AAPM Finance Committee and Board of Directors met in Chicago in December and reviewed the Association's current nancial position, as well as approving the budget for 2018. I am happy to report that 2017 was a successful nancial year for our Association.

FINANCIAL POSITION AND ESTIMATES FOR 2017 As of mid-December, I am pleased to report that AAPM will nish the year with a surplus from operations. While conservative reports provided to the Board in November indicated that we would complete the year with a modest surplus from operations, when factoring in a reduced spending pattern within the Councils and Committees through the end of the year and historical spending in the last two months of the year it is now estimated that, due to recent market gains, the Association will see a healthy surplus from operations as well as an increase in reserves. The 2017 budget, as approved by the Board of Directors, was developed using a statistical model to project revenue and expenses based on historical spending trends. As of October 31, revenue and expenses are estimated at $9.58 million and $10.48 million respectively compared to approved budgeted revenue of $9.55 million and expenses of $10.75 million. AAPM experienced better than anticipated revenues from Online Education and Summer School both contributing. On the expense side, Annual Meeting expenses came in nearly $300,000 below budget and overhead costs are pacing approximately $88,000 below budget. O setting a portion of these positive

variances is a negative variance in Publications. There was a budgeting error of $110,760 for the fee paid to Wiley for the hardcopy journals sent to AAPM members. This contributed to the negative expense variance in Publications of nearly $145,000. These factors are contributing to expenses pacing well below budget for the year. Currently, AAPM's investment portfolio saw substantial gains during 2017 recording - in excess of $1,200,000 of unrealized gains in the rst ten months of the year. Even after transferring out $660,000 to operations for the acquisition of the new Association Management System (AMS) and Financial Management System (FMS), the reserve fund exceeds $13.8 million as of October 31, 2017.


I would once again like to thank the Council and Committee Chairs, along with their liaisons, who worked extremely hard in developing their budgets. As reported in one of my earlier columns, the entire Finance Committee reviewed the 2018 budget with the Council Chairs while keeping the goals and objectives of AAPM's strategic plan in the forefront.

The 2018 budget summary is included with this report. Revenue projections total $9.45 million and expenses total $10.40 million, with a budgeted de cit of $954,787. The statistical model predicted a de cit of $946,490 which is based upon AAPM complying with the nancial covenants established by TD Bank, the mortgage holder for the new HQ building. Given our normal underspending patterns, the Finance Committee felt that the approved de cit would allow for AAPM to operate and still meet the bank covenants and operate at or near break-even from operations.

Included below you will nd a graphical presentation of the 2018 budgeted revenues and expenses by category (including which programs are included in the various categories). In closing, I would like to thank Robert McKoy and the entire AAPM nance sta for all of the help during this past year, and in making the budgeting process and the job of Treasurer manageable. Please feel free to reach out to me by email, Twitter, or call me at 410-955-5115, if you have any questions concerning this report.

Improving Health Through Medical Physics

EDUCATION COUNCIL REPORT William Parker, MSc | Montreal, QC, Canada AAPM Newsletter — Volume 43 No.1 — January | February 2018

CONTINUING PROFESSIONAL DEVELOPMENT COMMITTEE The Education Council looks for opportunities to inform the Membership about activities undertaken by the council as a whole or by its constituent committees. This edition's report from the Education Council will highlight the activities of the Professional Development Committee, chaired by William Parker. The purpose of the Continuing Professional Development (CPD) Committee is to ensure that su cient professional educational activities are available to AAPM members to develop and maintain their competencies through AAPM and through other organizations. This is achieved though liaisons and relationships with other AAPM committees, sub-committees, and external entities. The CPD reports directly to the Education Council (EC), with the CPD Chair appointed as a member of the EC. As of this year, three sub-committees report to the CPD: Maintenance of Certi cation SC, Online Learning Services SC, and RSNA Education Coordination SC. Historically, the Summer School SC and the Annual Meeting Education SC also reported through the CPD. Changes in the Meeting Coordination Committee (MCC) structure and charge have resulted in the aforementioned committees reporting to the MCC. The chairs of those sub-committees are now appointed as liaisons on the CPD to maintain continuity and integrity of the CPD. Currently the Committee Roster is made up of various ex-o cio and liaison members. The main activities of the CPD Committee are listed below: 1. Assess, periodically, the professional educational needs of the AAPM Membership. 2. Oversee the AAPM online educational content and program. 3. Support educational activities required for maintenance of certi cation. 4. Work with AAPM Summer School Committee to ensure that professional educational programs at the Summer School meet the needs of the AAPM Membership.

5. Work with the Meeting Coordination Committee to ensure that professional educational programs at the Annual Meeting meet the needs of the AAPM Membership. 6. Ensure coordination between the professional educational activities of the AAPM and those of related organizations and make recommendations to those organizations concerning the professional educational needs of medical physicists. 7. Provide, with the approval of AAPM Board, advice to other organizations and government agencies about the professional educational needs of medical physicists. 8. Ensure that AAPM engages in other professional educational activities as necessary. 9. Make recommendations to educational accreditation agencies, such as CAMPEP, concerning the accreditation of medical physics professional educational activities. 10. Oversee the sponsorship, endorsement, and co-sponsorship of professional educational activities in accordance with AAPM policies. 11. Prepare and ensure dissemination of a calendar of educational events of interest to medical physicists. 12. Arrange for the publication of professional educational materials. There are two active projects the Committee is involved in, both related to online educational content. The rst has resulted in the creation of a newly formed Task Group (TG) to examine possible ways to modernize the dissemination AAPM's Virtual Library to the Membership and public. The second is a work group currently being formed (under the OLE) to formalize a repository of other online materials to members following recommendations of TG 250. Most of the activities of the CPD are handled by the three sub-committees. A description of each of the SCs activities is given below.

MAINTENANCE OF CERTIFICATION SC (MOC) The Maintenance of Certi cation Subcommittee is charged to: 1. Act as a Resource to the ABR trustees and AAPM members concerning MOC requirements and implementation; 2. Provide information/suggestions on activities that meet MOC requirements; and 3. Insure that educational activities are available to members. Operationally, the MOC Committee is responsible for the approval of all Self-Assessment Modules (SAM) at AAPM Meetings. The Committee has a high workload and has a 16-person strong membership, led by SC Chair Michael Yester.


The primary goal of the Online Learning Services Subcommittee will be to provide various Continuing Education (CE), Self-Assessment Modules (SAM), and other online educational/learning opportunities to the AAPM Membership and others as permitted by AAPM via the association website and/or digital products. The SC is responsible for coordinating the e orts that pertain to such learning opportunities, which include activities such as: Oversight of the Online Continuing Education Program, Ensuring that credits earned online satisfy and are approved by ABR, CAMPEP, or other requirements, depending on the context, Recommending contracts with audio/visual contractors for video capture, Management of the Virtual Library, other special learning events, and webinars, Coordination of CE quizzes (journals, meetings, etc.) The SC works with organizers of AAPM (and AAPM-associated) 'in person' or face to face learning events to determine if content presented at such events should be digitally available and if so, coordinate this e ort. The SC is also responsible for the recommendation of participation fee schedules for online activities and pricing of related products. This very busy Committee is 16-person strong and currently led by Chuck Bloch. After many productive years at the helm, Chuck is rotating o the Committee and will be succeeded by Mi-Ae Park.

RSNA EDUCATIONAL COORDINATION SC (REC) The purpose of this Subcommittee is to coordinate and contribute to the planning of the various physics educational activities of the RSNA Annual Meeting in which AAPM members participate. The objective is to enhance the value of the educational activities to AAPM members, radiologists, and other healthcare professionals in attendance. This is another busy committee which has 10 members and is led by Jim Ko er. The Committee manages nine physics "Tracks" at the RSNA, over 90 educational talks, including the two physics tutorial sessions, the Monday Summer School Symposium, Basic Physics Lectures for the RT, and the "Case of the Day." The CPD Committee exists to serve the AAPM Membership, for further details please visit the CPD Committee website.

Improving Health Through Medical Physics

LEGISLATIVE & REGULATORY AFFAIRS REPORT Richard Martin, JD | Alexandria, VA AAPM Newsletter — Volume 43 No.1 — January | February 2018

HOUSE ADVANCES LOW-DOSE RADIATION RESEARCH The Low-Dose Radiation Basic Research Act of 2017 introduced in December 2017 before the U.S. House of Representatives would authorize a low-dose radiation research program within the Department of Energy (DOE) O ce of Science. The legislation would direct the O ce of Science to carry out a research program on low-dose radiation to enhance the scienti c understanding of and reduce uncertainties associated with the e ects of exposure to low-dose radiation. The bill also would direct the DOE to coordinate with other agencies, including the National Academies, to conduct a study assessing the current status and development of a long-term strategy for low-dose radiation research. It would also require the DOE to submit to Congress a four-year research plan that identi es and prioritizes research needs. AAPM has been proactive in its support of the pending bill, arguing that more research regarding the e ects of low-dose radiation is needed to optimize bene t to risk in medical use of radiation. In a letter to the House Committee on Science, Space & Technology (SST) Chair, Lamar Smith (R-TX), we stated, "Without additional knowledge, the medical community may be erring on the side of "overprotecting," which can lead to unnecessary increases in health care costs. For example, ordering a more expensive and time consuming MRI exam instead of a CT exam, simply because the CT exam uses ionizing radiation, increases both costs and delays in patient care. Data that might alleviate concerns about the low doses of radiation used in CT imaging would therefore contribute to improved and more coste cient medical care in a very practical way." The proposed bill would restart research and advance these goals. The bill follows on the November 1, 2017 House Committee on Science, Space & Technology (SST) Subcommittee on Energy hearing about the future of research on low-dose radiation. The Subcommittee explored what could be gained by restarting research programs on low-dose radiation in

DOE. Testimony supported the view that medical use of radiation has allowed some of the greatest advances in modern medicine, including the virtual elimination of exploratory surgery, the ability to diagnose disease earlier and monitor treatment for optimal patient care. Witnesses stressed the importance of continuing research in this area, advocating for more research on dosimetry, and the potential long-term e ects of low-dose radiation exposure. Also on November 1, 2017, the Government Accountability O ce (GAO) released a report entitled, "LowDose Radiation: Interagency Collaboration on Planning Research Could Improve Information on Health E ects" (GAO-18-184T). In that report, the GAO was critical of what it identi ed as a lack of collaboration among the agencies conducting low-dose research. It recommended better collaboration among those agencies as well as a bigger role for DOE in this research. Full text is available here. If you have questions or require additional information, contact Richard J Martin, JD, AAPM Government Relations Program Manager.

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ABR NEWS Kalpana M. Kanal, PhD | Seattle, WA AAPM Newsletter — Volume 43 No.1 — January | February 2018

DIVERSITY AND FAIRNESS WITHIN THE AMERICAN BOARD OF RADIOLOGY I began my role as the diagnostic medical physics trustee for the American Board of Radiology (ABR) in October 2017 at the ABR Fall Retreat in Tucson. I am excited about being the ABR's newest medical physics trustee because I truly believe that ABR certi cation is at the heart of clinical medical physics. I replaced J. Anthony Seibert, who is now serving on the ABR Board of Governors. At the October meeting, we said goodbye to Geo rey S. Ibbott, who completed his term as governor and as ABR Secretary/Treasurer. We will greatly miss Tony and Geo , whose many contributions and sage advice have been very important to us. During a recent meeting at which we assembled one of our exams, I noticed that two-thirds of the participants were women. This started me thinking a bit more about diversity within the ABR. While I am the rst woman who has served as a medical physics trustee, women and women physicists have a long and distinguished history in the organization, as well as a strong role today. At present, 27 percent of our 142 medical physics committee members are women. A little more than 20 percent of our oral examiners are women, and four of seven panels at the last Oral Exam were chaired by women. Regarding women in ABR leadership, our executive director, Dr. Valerie Jackson, and our president, Dr. Lisa Kachnic, are women. One-third of our associate executive directors and 44 percent of our directors are women. Women are also well represented on the Board of Governors and the Board of Trustees. We recently checked the performance of medical physics candidates on the Part 2 and Oral exams by gender. Women perform slightly better on the Oral Exam, and men perform slightly better on the Part 2 Exam. Neither di erence is statistically signi cant.

There is also some interesting history. The ABR began examining radiologists in 1934. Shortly thereafter, it decided that medical physics should be part of the radiology Oral Exam and asked Edith Quimby (photo) to be an examiner in 1936. She remained an oral examiner for more than 50 years. In those early days, medical physicists were certi ed by the RSNA. However, when the ABR began certifying medical physicists in 1947, Dr. Quimby was in the inaugural class. A couple of years later, Dr. Rosalyn Yalow was also certi ed by the ABR, and she remains the only diplomate of the ABR to receive the Nobel Prize. I am very pleased with the diversity, both historic and current, that exists within the ABR and will work to continue to enhance it. The ABR is always committed to increasing its diversity. If you would like to volunteer, an application is available on our website.

Improving Health Through Medical Physics

HEALTH POLICY & ECONOMIC ISSUES Wendy Smith Fuss, MPH | Delray Beach, FL AAPM Newsletter — Volume 43 No.1 — January | February 2018

CMS CONTINUES COMPREHENSIVE APCS IN HOSPITAL OUTPATIENT SETTING WITHOUT ADDRESSING DATA CONCERNS The Centers for Medicare and Medicaid Services (CMS) recently released the 2018 Hospital Outpatient Prospective Payment System (HOPPS) nal rule, which provides facility payments to hospital outpatient departments. All policies and payments are e ective on January 1, 2018. CMS nalized the proposal to eliminate the Low Dose Rate Prostate Brachytherapy Composite ambulatory payment classi cation (APC) for CPT 55875 + 77778 billed on the same day and instead assigned CPT 55875 Transperineal placement of needles or catheters into prostate for interstitial radioelement application, with or without cystoscopyto status indicator "J1" and to provide payment for this procedure through the Comprehensive APC payment methodology similar to the payment methodology for other surgical insertion procedures related to brachytherapy. CMS assigns CPT 55875 to C-APC 5375 Level 5 Urology Services with a 2018 payment of $3,705.77. For 2017, CMS established several new Comprehensive APCs for brachytherapy catheter/needle insertion codes (20555, 41019, and 55920) and other related brachytherapy procedures such as insert tandem and/or ovoids (57155) and insert Heyman capsules (58346). AAPM conducted an economic analysis of the most recent outpatient claims data and determined that some costs of associated radiation therapy services, including brachytherapy treatment delivery, were not captured in the bundled payment. AAPM recommended that CMS discontinue the Comprehensive APC (C-APC) payment policy and proposed code edits for all brachytherapy insertion codes identi ed in the 2018 rule. We expressed concerns that hospital billing practices for radiation oncology services are variable and inconsistent with the C-APC policy that packages services at the claim level. AAPM noted that, in some

cases, needles or catheters are surgically placed prior to the brachytherapy treatment delivery, which consists of multiple fractions over several days or weeks and may be delivered at a di erent site of service. Based on AAPM's written comments, CMS did not nalize the proposal to require a code edit when a brachytherapy insertion code is billed on an outpatient claim with a brachytherapy treatment delivery code but is continuing the C-APC payment policy for these codes. For stereotactic radiosurgery (SRS), CMS continues to make separate payments for the 10 planning and preparation services adjunctive to the delivery of the SRS treatment using either the Cobalt-60-based (77371) or LINAC-based (77372) technology assigned to Comprehensive APC 5627. In addition, CMS is deleting the required use of the "CP" modi er to identify services provided with 30 days of the SRS treatment but billed on a di erent claim. Based on AAPM's comments, CMS reassigned CPT 55920 Placement of needles or catheters into pelvic organs and/or genitalia (except prostate) for subsequent interstitial radioelement application from Comprehensive APC 5341 Abdominal/Peritoneal/Biliary Procedures to Comprehensive APC 5415 Level 5 Gynecologic Procedures, resulting in a 43.6% payment increase. Below is a summary of the nal HOPPS APC payments for 2018. Summary of 2018 Radiation Oncology HOPPS Payments APC


CPT Codes






Change 2017-2018


Level 1

77280, 77299, 77300,


77331, 77332, 77333,


77336, 77370, 77399







Treatment Preparation 5612

Level 2

77285, 77290,


77306,77307, 77316,


77317, 77318, 77321,


77334, 77338


Summary of 2018 Radiation Oncology HOPPS Payments APC


CPT Codes






Change 2017-2018


Level 3

32553, 49411, 55876,


77295, 77301, C9728
















Radiation Treatment Preparation 5621

Level 1

77401, 77402, 77407,


77789, 77799

Therapy 5622

Level 2

77412, 77600, 77750,


77767, 77768, 0394T

Therapy 5623

Level 3

77385, 77386, 77423,


77470, 77520, 77610,


77615, 77620, 77761, 77762



Level 4

77605, 77763, 77770,


77771, 77772, 77778,



Level 5

77522, 77523, 77525








Level 7

77371, 77372, 77424,






Radiation Therapy 5626

Level 6 Radiation Therapy


Therapy *Comprehensive


A complete summary of the nal rule and impact tables is on the AAPM website.

2018 FINAL RULE YIELDS POSITIVE IMPACT ON PAYMENTS TO PHYSICIANS AND FREESTANDING CANCER CENTERS The Centers for Medicare and Medicaid Services (CMS) recently released the 2018 Medicare Physician Fee Schedule (MPFS) nal rule. The MPFS speci es payment rates to physicians and other providers, as well as technical payments for freestanding cancer centers. It does not apply to hospital-based facilities. All policies and payments are e ective January 1, 2018. CMS updated the current conversion factor of $35.89 to $35.99 in 2018, which results in payment increases for the majority of radiation oncology codes. CMS identi ed the complex treatment planning code 77263 as being "potentially misvalued" under the high expenditure services review screen. The simple and intermediate treatment planning codes (77261, 77262) were also included for review. CMS nalized the RUC-recommended work relative value units (RVUs) as noted in the table below. CPT

Current 2017 Work RVU

Final 2018 Work RVU










CMS adds two new codes for 2018: 19294 Preparation of tumor cavity, with placement of a radiation therapy applicator for intraoperative radiation therapy (IORT) concurrent with partial mastectomy; and 55874 Transperineal placement of biodegradable material, peri-prostatic, single or multiple injection(s), including image guidance, when performed. CMS will notadd the proposed code (GRRR1) to describe super cial radiation treatment planning and management services. CMS modi ed the proposal to revise the Physician Fee Schedule Relativity Adjuster for nonexcepted items and services furnished by nonexcepted o -campus provider-based department from 25 percent to 40 percent of the 2018 HOPPS payment rate. In response to public comments, CMS is further delaying the e ective date for the appropriate use criteria (AUC) consultation and reporting requirements for this program from January 1, 2019 as proposed to January 1, 2020. For 2018, CMS did not nalize any of the malpractice RVUs proposals.

The 2018 nal rule policies result in an overall positive one percent payment increase to radiation oncologists and freestanding cancer centers andno payment change to radiologists. To read a complete summary of the nal rule and to review impact tables, click here

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Student and Trainees Subcommittee Report Nicky Mahon, MS, Sta ord, VA | Mallory Glenn, BS, Houston, TX AAPM Newsletter — Volume 43 No.1 — January | February 2018

The Students and Trainees Subcommittee at the 2017 Annual Meeting

The Student and Trainees Subcommittee (STSC) would like to update the membership on its activities from the previous year and present new and upcoming initiatives. We are delighted to share the ongoing actions undertaken by this dedicated group of students, trainees, and mentors who continue to keep the AAPM's most junior members engaged and informed.

2017 ANNUAL STUDENT MEETING EVENTS To kick o the 2017 AAPM meeting in Denver, Colorado, the American College of Radiology (ACR) and STSC co-hosted a meet-and-greet at Pizza Republica, where students and trainees found pizza- lled camaraderie and networking among ACR's leadership. The next morning, the second annual Student and Trainee Day provided numerous opportunities for students to engage with one another, as well as

with professionals in clinical and industry careers. The Annual Student Meeting was themed "Provocative Questions in Medical Physics Training" and included presentations and lively debates concerning several topics of interest, such as the Doctorate of Medical Physics (DMP) degree. This was followed by the Career Expo at the Working Group on Student and Trainee Research (WGSTR) Lunch, co-hosted by the STSC. Here, participants conversed with representatives from various companies ranging from small start-ups to industry leaders. At the second annual Residency Fair, over 130 attendees mingled with 58 residency programs, giving interested students and trainees the one-of-a-kind opportunity to meet with representatives from residency programs in one place prior to applying. Following the day's events, over 200 students, trainees, and young professionals attended the Student and Trainee Night Out at the Great Divide Barrel Bar which provided a jovial atmosphere for students, residents, and post-docs to network over snacks and games. Special thanks to the sponsors of this year's Student and Trainee Night Out event: ZapIT Medical, ScandiDos, and the University of Wisconsin Radiation Calibration Laboratory. In addition to these programs, the STSC has continued its tradition of holding the Interview Workshop, where over 50 students and young professionals engaged with skilled interviewers to improve their communication skills. David Piantino and Robin Miller from the Professional Services Committee began with an introductory "how-to" for interviewing before trainees had an opportunity to participate in mock interviews with a range of interviewers from clinical, academic, industry, and regulatory backgrounds. We received positive feedback about the "event [being] clearly very well organized" and that "the trainees got a lot out of it." Likewise, we continued our support for the Partners for the Future program by providing guided tours of the vendor booths to introduce students to participating corporate a liates. This year we helped incentivize students to participate through the new addition of a scavenger hunt; once students visited all the corporate partners and learned about their products and opportunities for collaboration, they were eligible for a drawing for a $100 Amazon gift card. Congratulations to our 2017 scavenger hunt winner, OphĂŠlie Piron! Beyond our typical programming, STSC was also involved in increasing undergraduate and youth involvement in medical physics. The rst ever Med Phyz Wiz Kidz event, spearheaded by Dr. Julianne Pollard-Larkin and the Women's Professional Subcommittee (WPSC), brought approximately 30 students between the ages of 12 and 17 to stimulate interest in science and expose younger minds to the eld of medical physics. The students listened to talks given by a number of female physicists from di erent elds to understand how diverse medical physics is. STSC and WPSC members then provided guided tours through the exhibit hall with this diverse group. Joint Society of Physics Students SPS-AAPM undergraduate members presented their research during the SPS Undergraduate Research & Outreach poster session, and the WGSTR facilitated a clinical tour of the Radiation Oncology and Radiology departments at the University of Colorado Hospital for a small group of SPS and local undergraduate students. Thank you to the UC Department of Radiation Oncology for hosting us! Additionally, STSC hosted an Undergraduate Networking Session and supported an undergraduate "buddy" system with current AAPM members to help guide younger students through the exhibit hall and scienti c sessions.

UPCOMING STSC INITIATIVES AND PROGRAMS FOR 2018 Because of the positive responses we received following the 2017 Annual Meeting, we will be continuing many of our current initiatives, along with some additions. 2018 is sure to be our most exciting year yet, with new events and information being brought your way! MedPhys Slam: At the 2018 AAPM Annual Meeting we are debuting a new competitive event, the MedPhys Slam. The rules are simple: you have three minutes to present your original research (accompanied by three PowerPoint slides) to a panel of judges from the local community. Each AAPM chapter, COMP, and an international section will select one representative to send to the nal event at the 2018 Annual Meeting in Nashville, Tennessee. Think you have what it takes to communicate your research to a general audience in such a short time? Then be sure to ask your local AAPM chapters about their preliminary MedPhys Slam events and join us for the nals in Nashville. Cash prizes will be available for the best presentations. New Blog Series on Non Clinical Career Pathways: The Working Group To Promote Non-Clinical Career Paths for Medical Physicists (WGNCMP) has begun publishing its paper that explores non-clinical career options for medical physicists through regular installments on our blog. This paper outlines potential positions, possible training requirements, current attitudes, and awareness of non-clinical careers. Be sure to watch our blog for upcoming segments. You can also look for the full paper to be published on the AAPM Student page. 2018 Annual Student Meeting Events: We are excited to announce that the 2018 Annual Student Meeting will be themed "Breaking Out of the Clinic" and will focus on what non-clinical careers are available to medical physicists, as well as how to prepare for them as a student, trainee, or clinical physicist. Our panelists are sure to spark thought-provoking discussions. Following the meeting, the Career Expo, hosted by WGNCMP, will be taking place. This time around, in order to maximize the ability for attendees to connect with many di erent companies, we are implementing a speed dating format!

Meeting attendees took time to socialize during the WGSTR Lunch/Career Expo

The WGSTR will be hosting the annual student luncheon, themed: "Committees, Councils, and Task Groups, Oh My! How to Get Involved in the AAPM." Join us to meet active AAPM members, learn about the AAPM committee structure, and discover ways that student and trainee members can engage in AAPM activities. In the afternoon, the third annual Residency Fair will commence, where we hope to see high turnout among students and residency programs alike. Partners for the Future will return in Nashville and continue to encourage student and trainees to visit vendors and learn about how their products and services can bene t future practice. The feedback from the 2017 meeting was exceptionally positive, so we anticipate continuing the scavenger hunt and guided tours at the 2018 Annual Meeting. Come learn about the latest trends in related elds at the poster session highlighting this year's winners of the Expanding Horizons Travel Grant. Lastly, the Interview Workshop will re-appear to help those getting ready to apply for residencies, post-docs, and employment opportunities to sharpen their interview skills and receive feedback from experienced interviewers. Sign-ups for the workshop will be available this summer.

EXCITING OPPORTUNITIES FOR STUDENTS AND TRAINEES Internships: Looking for a summer internship? The AAPM job website now has an internship category! With this new category you can view new listings or provide your information so employers can get in direct contact with you. Check out the listings. Graduate Fellowships and Grants: The AAPM has a host of travel grants and fellowships available for student and trainee members, including the BEST Medical/AAPM Travel Fellowships, the Expanding Horizons Travel Grant, and the AAPM Graduate Research Fellowship. See the full list of available opportunities and deadlines on the AAPM Grants and Fellowship Page. Deadlines are quickly approaching – including a *NEW* call for additional Expanding Horizons Travel Grants coming up in February – so don't miss your chance!

Undergraduate Opportunities: Undergraduates are encouraged to submit their research abstracts for the Society of Physics Students Poster Session at the 2018 Annual Meeting. These undergraduate students get to share their work with the AAPM community at large during the General Poster Session on the rst day of the conference. The STSC will also host an Undergraduate Networking Session following our annual student meeting. In addition, the AAPM o ers both the DREAM and Summer Undergraduate Fellowship Programs. Both programs o er 10 weeks of research experiences with medical physicists and a $5,000 stipend. Please note that deadlines are quickly approaching. You may nd more information on the AAPM Grants and Fellowship page.

learn more about residency programs at the Residency Fair

STAY INFORMED: FOLLOW US ONLINE! The STSC has endeavored to increase our social media presence this past year through regular blogging and social media posts. You can follow us on Twitter and Facebook for the latest updates and information. In addition, we are continuing our blog with hopes to discuss student and trainee speci c topics in further detail. Upcoming events, ways for students to get involved, and topics of interest will be featured on both our Facebook page and Twitter feed. Job postings, post-doctoral positions, and residency announcements will be posted on both Facebook and Twitter as information becomes available (but please note that not all positions may appear on both platforms, so follow both accounts for full details). While we are happy to share our news with you, we would love to hear from you too! If you are doing some interesting work, win an award, or have a something you want to share, please let us know on Twitter or on our Facebook page! We are happy to review and share any information bene cial to medical physics students and trainees (i.e., graduate program news, residency positions, fellowship opportunities, etc.). If you have any suggestions for discussion topics, events, or other initiatives to support students and trainees within AAPM, feel free to contact us. We look forward to hearing from you!

Improving Health Through Medical Physics

ANNUAL MEETING SUBCOMMITTEE REPORT Robin Stern, PhD | Sacramento, CA AAPM Newsletter — Volume 43 No.1 — January | February 2018

The Annual Meeting Subcommittee and its Working Groups are already hard at work putting together an exciting program for the 2018 Annual Meeting in Nashville, TN. But before I get to the program itself, I want to introduce the team behind it. I am the Chair of the new Annual Meeting Subcommittee, and Ingrid Reiser is the Vice Chair. The Scienti c Program is headed by Kristy Brock. Shuai Leng and Joseph Stayman are the Scienti c Imaging Track Director and Co-Director, while Lei Xing and Carri Glide-Hurst are the Director and Co-Director for the Scienti c Therapy Track. Lei and Shuai are also the Directors for the Scienti c Joint Imaging-Therapy Track. The Education Program is headed by Tyler Fisher. Rick Layman and Georgeta Mihai are the Education Imaging Track Director and Co-Director, and Stephen Thompson and Robin Miller are the Director and Co-Director for the Education Therapy Track. Brian Wang is Director for the Practical Track, and Tyler also serves as the Co-Director. For the Professional Program, Je rey Limmer is the Program Director, while Eileen Cirino and Erin Angel are the Professional Track Director and Co-Director. The meeting program itself is shaping up well. Highlights include a 2-day Specialty Track on QIN/QIBA organized by Ed Jackson and Paul Kinahan. The Certi cate Course, organized by Hugo Aerts and Laurence Court, will be on the topic of Computational Advances. The Anne and Donald Herbert Distinguished Lecture in Statistical Modeling will discuss QUANTEC: analysis of heterogeneous big data using modern statistical methods. More details about the program can be found here. New for this year is the Med Phys Slam, a joint e ort of the Students and Trainees Subcommittee and the Scienti c Program. Each AAPM Chapter will select one student/graduate student/resident champion to represent them. The chapter champions will give short presentations which will be judged on the quality of the presentation, particularly comprehensibility, communication skills, and audience engagement. Winners will be determined and awarded. Come and cheer on your chapter champ!

A helpful new feature we’re implementing this year is the use of keywords to help you navigate the program and nd those presentations of particular interest to you. Each presentation will have one category and up to three keywords associated with it. These will be the same categories and keywords used by Medical Physics and JACMP. Authors will be requested to select the category and keywords when submitting their abstracts. See you in Nashville!

Improving Health Through Medical Physics

PENN-OHIO CHAPTER REPORT Andrew Godley, PhD | Cleveland, OH AAPM Newsletter — Volume 43 No.1 — January | February 2018

The Penn-Ohio chapter held its annual Fall Meeting in May eld Village OH October 13-14, 2017. The theme of the meeting was "Online Imaging for Radiotherapy." Research presentations from six trainees (masters students and residents) opened the proceedings. In keeping with the theme, Anthony Magnelli (CCF) then spoke on using kV imaging throughout treatment to track ducial markers and Rick Jesseph (UH) introduced us to the imaging and motion management techniques used in proton therapy. A poster and social session began after the talks, with a chance to reacquaint ourselves with colleagues from our chapter. For our Night In, there was a pertinent talk over dinner by Ehsan Samei (Duke) on MedPhys3.0. This is a vital subject for all medical physicists, and as would be expected, the talk generated over an hour of lively discussion. Many ideas were formulated on how we could demonstrate and increase our value in our profession and to physicians and administrators.

Dr. Gregory Warrell receiving his award for best trainee talk from Chapter President Mr. Kurt Blodgett (left), and meeting with vendors (right).

After Saturday's breakfast, Dr. Samei returned to supply an example of how physics is improving diagnostic imaging, detailing his research of tangible tools for dose and image quality monitoring. Our keynote speaker was Allen Li from the Medical College of Wisconsin, outlining their newly installed MRlinac. These machines will become the standard for online imaging for radiotherapy, and it was exciting

to see the promise they hold. Concluding the online imaging theme, Tarun Podder (UH) presented speci cs of motion management for SBRT, and Ping Xia (CCF) detailed the use of real-time ultrasound to monitor intra-fraction motion of prostate and liver tumors.

Dr. Eshan Samei from Duke giving our Night-In talk on Med Phys 3.0

During the Business Lunch, four vendors presented their latest updates. There were ve more trainee talks around the lunch. The nal speaker of the meeting was Frank Dong (CCF), giving an educational SAM session on iterative reconstruction in CT. Before the meeting concluded, we voted for the best trainee talk. Gregory Warrell (UH resident) was selected for his talk "Direct Dose Comparison of LinacBased Total Body and Total Marrow Irradiation Treatment Plans." I would like to thank everyone who attended (29 exhibitors, nine speakers and 10 trainees among 88 chapter members) for their participation and support. See you all at our spring meeting in April 2018.

Keynote speaker Dr. Allen Li from the Medical College of Wisconsin presenting their MRI-Linac

Friday evening poster session.

Improving Health Through Medical Physics

OHIO RIVER VALLEY CHAPTER REPORT Ashley Cetnar, MS | Columbus, OH AAPM Newsletter — Volume 43 No.1 — January | February 2018

OHIO RIVER VALLEY FALL SYMPOSIUM 2017 The Ohio River Valley Chapter hosted our Fall Symposium November 3-4 where over 100 participants came together in Indianapolis, IN. The meeting events started Friday night with a poster session, dinner, and meet and greet where physicists, students, residents, and vendors were able to catch up with colleagues, network with new people, and discuss current research within the chapter. We were happy to host a wonderful group of guest speakers for the symposium and provide the opportunity for our chapter members to receive SAM credits for the symposium. On Saturday, the event was started with the keynote presentation by then AAPM President-Elect, Bruce Thomasdsen, to discuss AAPM initiatives in patient safety. Guest speakers included Cedric Yu questioning where we can nd room for improvement in radiation therapy techniques, Sam Beddar sharing his experience with invivo dosimetry for both external beam and brachytherapy, and Jonathan Feddock with helpful insight from a physician's perspective on teamwork and the important role of the physicist in the clinic.

Bruce Thomasden, PhD and Wei Luo, PhD preparing for the Keynote Speech

Over 100 participants were in attendance for the ORVC Fall Symposium this year

The afternoon was lled with talks sharing research and clinical experience. Guest speakers included Jun Deng presenting deep learning with big health data for early cancer detection and prevention, Anil Sethi sharing his experience with clinical implementation of SRS and SBRT, and concluded with Quan Chen's call to the chapter for engagement with the community in promoting Radiation Therapy and Professional Medical Physics.

We look forward to our upcoming Spring Clinical Symposium where we will host our 3rd annual mock oral as a service for professionals preparing for their upcoming board exam. We also are excited to incorporate a MedPhys Slam format for students in our region to present research in a short presentation to clearly communicate the signi cance of their work in an engaging way. The winner of the regional competition will be selected as representative of our chapter to compete nationally at the 2018 AAPM Annual Meeting.

Participants discussing research at the Friday Night Poster Session

Attendees sharing dinner together and enjoying the Friday Night Poster Session

We would like to thank all of the vendors that made this event possible. We appreciate all of the guest speakers who shared their research for the symposium. Finally, we would like to thank the student volunteers and all of the hard work of the chapter o cers for another successful meeting.

Improving Health Through Medical Physics

AAPM ANNUAL MEETING AND PRESIDENT'S SYMPOSIUM Bruce Thomadsen, PhD | Madison, WI AAPM Newsletter — Volume 43 No.1 — January | February 2018

SYMPOSIUM THEME: BEYOND THE FUTURE Medical physicists, and medical physics as a eld, face many challenges and potential threats. Most of these are economic in nature, from massive cuts to medical physics research from national agencies to changing patterns for reimbursement. Others may be changes in clinical practice, such as increasing use of physicists' assistants, or technological advances, possibly great strides in immunotherapy. In the recent past, discussions at AAPM have focused on preparing for the future or sometimes trying to predict the future. Predicting can only allow preparation for the near future, that which can be seen, however dimly. To remain relevant, we, medical physicists and AAPM, need to try to drive conditions to create a friendly environment in the farther future. Thus, the oxymoron of the theme stresses that AAPM's planning needs to look past the future as we see it, while recognizing that however diligently we plan, there should be no expectation that the future will follow the plan. That being understood, the more we plan, the better prepared we will be to adapt our plan to changing conditions. Part of a good plan is for AAPM to be one of the forces that shapes the changes that we encounter. This year's President's Symposium will address various aspects of the future, considering the agents of change mentioned above, where medical physics may head and how we should think about planning. We have an exciting lineup of speakers, including Paul B. Brown, author of Own Your Future and many

other books on shaping your destiny. Robert Jeraj will talk about new frontiers for medical physics. I am hoping that through the meeting, we all discuss the challenges and share our thoughts. I look forward to seeing you at the meeting and hearing your ideas.

Improving Health Through Medical Physics

INTERNATIONAL DAY OF MEDICAL PHYSICS 2017 John E. Damilakis, PhD | Crete, Greece AAPM Newsletter — Volume 43 No.1 — January | February 2018

THE WHOLE WORLD LEARNED SOMETHING ABOUT MEDICAL PHYSICS IOMP (International Organization of Medical Physics) celebrated the 5th International Day of Medical Physics (IDMP) by organizing three international events in Jaipur, Kuala Lumpur and Vienna in cooperation with the Asia-Oceania Congress of Medical Physics, the University of Malaya, the World Health Organization (WHO), the International Atomic Energy Agency (IAEA) and the University of Malaya. All three events were broadcasted live. In Jaipur, the inauguration program started with the "lighting of IDMP lamp" procedure and the release of IDMP poster. IDMP program included a rally and sessions on "Medical Physics Education", "Female Medical Physicist: Global and Regional Perspective" and "Radiation Protection of Women Patients". A special "IOMP-IDMP program" session was streamed live on the IDMP webpage. More inforrmation about these IDMP activities can be found here. A global webcast on "Marie Curie's Life and Achievements" organized by the University of Malaya in cooperation with IOMP and the WHO was successfully organized in Kuala Lumpur. The webcast was streamed live on YouTube. Program included 3 presentations on "IDMP: What, Why, How, Wxpectations and Outreach Achieved", "Building on Marie Curie's legacy for strengthening radiation safety culture in healthcare" and "Madam Marie Curie - A great scientist's contribution to human kind". The webcast can be accessed here. The IAEA in cooperation with the IOMP hosted a panel discussion at its headquarters in Vienna entitled "Medical Physics in Cancer Treatment: Supporting Women's Health". During this event, experts from di erent countries and from di erent disciplines highlighted the contributions of medical physics to support women's health. The slides and the programme of this panel discussion are available for download.

The momentum of IDMP continues to increase. IDMP 2017 was celebrated in many countries all over the world: Austria, Bangladesh, Belgium, Canada, Germany, Ghana, Greece, India, Iran, Italy, Malaysia, Moldavia, Portugal, Poland, Romania, Spain etc. I would like to heartedly thank colleagues who have sent material from the IDMP events they have organized. You can nd more information about IDMP activities here.

IDMP celebration in Jaipur: Introductory speech by Dr. Arun Chougule

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